Provider Demographics
NPI:1982121950
Name:BURNETTE, CATLYNN MARIE
Entity Type:Individual
Prefix:
First Name:CATLYNN
Middle Name:MARIE
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17479 IDYLWILD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:44429-9759
Mailing Address - Country:US
Mailing Address - Phone:330-398-8286
Mailing Address - Fax:
Practice Address - Street 1:310 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3211
Practice Address - Country:US
Practice Address - Phone:330-839-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1701276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health